POS0980 ADAPTING TO LIVING WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)
Authors: M. Garrido-Cumbrera, D. Poddubnyy, C. Bundy, S. Makri, R. Mahapatra, J. Correa-Fernández, L. Christen, C. J. Delgado-Domínguez, V. Navarro-Compán
Journal: Annals of the Rheumatic Diseases (2022)

Background Axial spondyloarthritis (axSpA) is associated with a high disease burden which may require patients to make functional adaptations in response to the disease Objectives The aim is to identify factors associated with implementing functional adaptations due to axSpA. Methods Data from 2,846 unselected patients participating in EMAS, an online survey (2017-2018) across 13 European countries, were analysed. Adaptations were assessed by: “Please indicate any steps you have taken since you have been affected by Spondylitis/ Spondyloarthritis?” with possible answers: purchasing customized or comfortable shoes, workplace or home or car adaptations. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health via the General Health Questionnaire GHQ-12 (0-12) were collected. Univariable and multivariable logistic regression models were used to identify variables associated with life adaptations, including sociodemographic factors, PROs, employment status, health behaviours, and comorbidities (n= 2,754). Results Mean age was 43.8 years, 61.5% female, 48.9% had a university degree, and 67.6% married. 76.9% (n=2,118) patients had made at least one adaptation: 72.0% (n=1,525) purchased customised or comfortable shoes, 54.9% (n=1,163) adapted their workplace, 40.7% (n=861) their home, and 29.0% (n= 614) their car. Compared to those who did not require adaptations, those who made adaptations were typically female (78.9% vs. 73.7% male, p=0.002), separated/divorced/widowed (82.0% and 80.0% vs. 71.5% singles, p=0.002), had retired early, or were on sick leave (temporary or permanent) (85.0%, 84.0%, 84.3% vs. 74.5% of employed), members of a patient organisation (81.5% vs. 74.0% of non-member, p&lt;0.001), physically active (78.9% vs. 66.5% vs. not physically active, p&lt;0.001), and overweight/obese (78.6% vs. 75.1% of underweight/normal weight). Those requiring functional adaptations reported greater BASDAI (5.7 vs. 4.9), functional limitations (21.4 vs. 16.5), poorer mental health (5.2 vs. 4.3), and longer diagnostic delay (7.9 vs. 6.0), all p&lt;0.001. The variables independently associated with functional adaptations were being physically active (OR=1.98), patient organisation membership (OR=1.39), female gender (OR=1.31), being overweight or obese (OR=1.26), separated, divorced or widow status (OR= 1.20), higher BASDAI (OR= 1.14) and functional limitation (OR= 1.01; Table 1). Table 1. Regression analysis for variables associated with the presence of at least one functional adaptations (n= 2,162) Univariable logistic analysis Multivariable logistic analysis OR 95%CI OR 95%CI Gender . Female 1 1.34 1.12, 1.60 1.31 1.06, 1.63 Marital Status . Separated/divorced/widow 2 1.33 1.14, 1.55 1.20 1.00, 1.44 Employment status . Sick leave/early retirement 3 1.83 1.45, 2.32 1.17 0.89, 1.53 Patient organization . Member 4 1.55 1.29, 1.88 1.39 1.12, 1.74 Physical activity 1.88 1.51, 2.35 1.98 1.52, 2.59 Body Mass Index . Overweight/obesity 5 1.22 1.02, 1.46 1.26 1.02, 1.55 BASDAI (0-10) 1.21 1.16, 1.27 1.14 1.07, 1.22 GHQ-12 (0-12) 1.06 1.03, 1.08 1.01 0.98, 1.04 Functional Limitation (0-54) 1.02 1.01, 1.03 1.01 1.00, 1.02 Spinal Stiffness (3-12) 1.10 1.06, 1.14 0.99 0.94, 1.03 Diagnostic delay 1.03 1.02, 1.04 1.01 0.99, 1.03 Anxiety 1.26 1.03, 1.54 0.87 0.65, 1.18 Depression 1.56 1.25, 1.95 1.31 0.95, 1.79 Sleep disorders 1.54 1.27, 1.86 1.17 0.91, 1.51 1 Male vs. Female; 2 Separated/divorced/widow vs. married/single; 3 Sick leave/early retirement vs. other employment status; 4 Member vs. non-member; 5 Overweight/obesity vs. underweight/normal weight Conclusion Three out of four axSpA patients made at least one functional adaptation due to their axSpA, which were often implemented by those with higher body weight, disease activity, engaging in physical activity, and patient organization membership. This is most likely explained by need as those with high disease burden or weight may face limitations, which can be alleviated through functional adaptations, enabling them to engage in physical activity. Acknowledgements This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study. Disclosure of Interests Marco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Raj Mahapatra: None declared, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Grant/research support from: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB